Interdisciplinary Children's Behavioral Health Workforce Development for Social Work and Nursing

This paper will begin with a review of child health inequities globally, in the United States and in the State of New York. It will then describe a model training program that was designed to educate social workers and nurse practitioners to create a workforce able to address child behavioral health inequities in the United States (US), specifically New York State. Behavioral health care refers to prevention, care and treatment for mental health and substance abuse conditions as well as physical conditions caused by stress and life crises. This project uses an interdisciplinary training program for nurse practitioner and Master of Social Work students to address workforce shortages in underserved communities in New York State. It will present process evaluation findings to highlight the program's initial success and will conclude with a discussion of the data that are still needed and the challenges of obtaining this data.

Designing a Nurse-Led Program for Self-Management of Substance Addiction Consequences: A Modified e-Delphi Study

Therapeutic interventions for people with problematic use of psychoactive substances can help tackle specific needs related to substance addiction consequences. This modified e-Delphi study aimed to establish consensus on a training program for self-management of substance addiction consequences. The study was conducted between February and April 2022, with an experts' sample of 28 participants in the first round and 24 in the second. A priori consensus criteria were defined for each round. The results revealed a very strong consensus was achieved on the structure of the program and on clinical areas, such as the problematic use of substances, general health knowledge, health-seeking behavior and adherence, self-knowledge and well-being, social role and personal dignity, and family process. Additionally, over 80% participant consensus was achieved on an extensive number of interventions categorized as psychoeducational, psychotherapeutic, socio therapeutic, brief interventions, social skills training, problem solving techniques, relaxation techniques, and counseling. These findings may be able to fulfill a gap concerning structured treatment approaches for people with problematic use of psychoactive substances. Supporting self-management of the consequences of substance addiction and its application can change nurses' interventions.

The Patient's Role in Patient Safety

Keeping patients safe while they receive medical care is essential. Yet current systems designed to ensure patient safety are not enough, because medical error is the third leading cause of preventable deaths in the United States. Clinicians can partner with the patient to enhance patient safety. Pulse Center for Patient Safety proposes patient- and family-driven processes designed to improve a patient's chances of avoiding harm. This article discusses highlights of the role of patient safety through a grassroots lens, summarizes the factors that influence the patient's role in patient safety and reviews recommendations on how clinicians can partner with patients.

Model of hard spheroplatelets near a hard wall

A system of hard spheroplatelets near an impenetrable wall is studied in the low-density Onsager approximation. Spheroplatelets have optimal shape between rods and plates, and the direct transition from the isotropic to biaxial nematic phase is present. A simple local approximation for the one-particle distribution function is used. Analytical results for the surface tension and the entropy contributions are derived. The density and the order-parameter profiles near the wall are calculated. The preferred orientation of the short molecule axes is perpendicular to the wall. Biaxiality close to the wall can appear only if the phase is biaxial in the bulk.

Salmonella enterica arthritis in a patient with rheumatoid arthritis receiving anti-tumour necrosis factor therapy

Anti-tumour necrosis factor (TNF) monoclonal antibodies have become an invaluable treatment against chronic inflammatory diseases such as rheumatoid arthritis (RA). However, due to increased risk of opportunistic infections, patients receiving anti-TNF therapy should be closely monitored for serious infections. Here, we describe a case of acute Salmonella_enteritidis infection of a joint arthroplasty that previously was functioning well, in a patient receiving infliximab treatment for RA. After prolonged antimicrobial chemotherapy and interrupted infliximab treatment, reimplantation of a new prosthesis was successfully performed two years after Salmonella septic arthritis. Therefore, because of the possibility of extraintestinal salmonellosis, screening for fecal colonization could be advisable in patients undergoing anti-TNF treatment. Moreover we emphasize the importance of appropriate counselling of these patients concerning food hygiene.

Endogenous gas gangrene after laparoscopic cholecystectomy

Clostridial gas gangrene of the abdominal wall is rare, and it is usually associated with organ perforation, immunosuppression or gastrointestinal malignancies. In this paper we present a case of fulminant, endogenous gas gangrene in a 58-year old diabetic female with arterial hypertension and atherosclerosis, following uneventful laparoscopic cholecystectomy. She developed gas gangrene of the abdominal wall 12-hours after cholecystectomy and died 24-hours after the onset of the first symptoms, in spite of treatment.

Effect of root canal sealers on mouse peritoneal macrophage functions

Three root canal filling materials, viz. calcium hydroxide-based cement (Apexit, resin-based cement (AH-plus) and glass-ionomer based material (Ketac Endo) were tested for their influence on several functions of peritoneal macrophages from Balb/c mice. Macrophage functions were evaluated by the adherence, phagocytic, candidacidal and Nitro blue tetrazolium-dye assays. Ketac-Endo enhanced all macrophage functions in the first 2 d (p < or = 0.05), when compared to the positive control, but this effect had changed after 7 and 14 d, causing inhibition of these functions. Other materials suppressed substrate adherence capacity and phagocytosis, while significantly stimulating macrophage microbicidal activity (p < or = 0.05) in a time-dependent manner.

Differential polymerase activity in avian and mammalian cells determines host range of influenza virus

As recently shown, mutations in the polymerase genes causing increased polymerase activity in mammalian cells are responsible for the adaptation of the highly pathogenic avian influenza virus SC35 (H7N7) to mice (G. Gabriel et al., Proc. Natl. Acad. Sci. USA 102:18590-18595, 2005). We have now compared mRNA, cRNA, and viral RNA levels of SC35 and its mouse-adapted variant SC35M in avian and mammalian cells. The increase in levels of transcription and replication of SC35M in mammalian cells was linked to a decrease in avian cells. Thus, the efficiency of the viral polymerase is a determinant of both host specificity and pathogenicity.

Antimicrobial use at a university hospital: appropriate or misused? A qualitative study

OBJECTIVE

To evaluate the quality of antimicrobial drug use in a university hospital medical department (Department of Medicine, University Hospital Rijeka, Croatia) with 279 hospital-beds in wards containing patients from endocrinology, gastroenterology, hematology, clinical immunology, cardiology and coronary care unit, nephrology and pulmonology sections of the hospital.

METHODS

The appropriateness of antimicrobial treatment for all in-patients in the Department of Medicine was assessed in a prospective, longitudinal survey carried out during a 21-week period using Kunin's criteria where Categories I and II indicate "appropriate therapy", Categories III and IV indicate major deficiency in the choice or use of antimicrobials. Category V indicates unjustified antimicrobial administration.

RESULTS

During the study period, a total of 438 patients were treated with antimicrobials in the Department of Medicine. Of these, 159 (36%) received antimicrobials appropriately (Category I and II), 180 (41%) needed antimicrobials (Category III and IV) but they should have been prescribed differently. The main reason for inappropriate antimicrobial treatment was the wrong choice of antimicrobials (broad-spectrum where a narrow spectrum antibiotic would have been sufficient). In the case of 99 patients (23%) an indication for antimicrobial therapy did not exist (Category V).

CONCLUSION

The main reason for suboptimal use of antimicrobials was the over-prescribing of broad-spectrum antimicrobials. This situation should be corrected e.g. by changes in the post-graduate medical teaching program.

Influence of calcium hydroxide root-canal sealer on microbial growth in vitro

The calcium hydroxide-based filling material Apexit, which is often used in endodontic practice, was evaluated for its antibacterial and antifungal effects against microorganisms isolated from oral cavity (Serratia marcescens, Pseudomonas putida, Staphylococcus aureus, Candida albicans). Two different quantitative techniques were employed--the direct-contact test was used to examine the efficacy of freshly mixed material while the broth-survival test was employed to check the antimicrobial properties of 5-d-old material. Apexit inhibited Gram-negative bacteria more effectively than Gram-positive ones but had none or a very weak inhibitory effect on C. albicans.

Plasma cytokine response in mice with bacterial infection

BACKGROUND

Exposure to microorganisms elicts the production of cytokines. These soluble factors enhance several innate immune functions and regulate the ensuing specific immune response aimed at limiting the spread of infection.

AIM

This study was undertaken to quantify the plasma levels of pro-inflammatory cytokines during the course of primary Listeria monocytogenes and Campylobacter jejuni infection. Using an in vivo infection the relationship between endogenous cytokines and the bacterial number in the liver of infected animals was examined.

METHODS

C57BL/6 mice were infected by the intraperitoneal route. At different time points we determined the number of colony-forming units of bacteria in the liver of infected animals and paralled these with the plasma levels of interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) measured by enzyme immunoassays.

RESULTS

L. monocytogenes infection lasted 10-11 days. IFN-gamma production occurred in the early phase but was more pronounced after day 4, following the appearance of specific immunity. The duration of experimental campylobacteriosis was 15 days. Early IFN-gamma production was not significant but a progressive rise of this cytokine in plasma was seen during the second week post infection. Mice produced measurable amounts of plasma TNF-alpha immediately after being given viable L. monocytogenes, peaking on day 2-3 when the greatest number of bacteria was present in the examined organs. During C. jejuni infection plasma TNF-alpha was produced in a similar manner, but the highest concentrations were found a few days later than in listeriosis, in correlation with the different course of campylobacteriosis. The quantity of IL-6 increased and decreased in concordance with clearance of L monocytogenes and the clinical status of the animals. C. jejuni did not promote the induction of this cytokine. This is to some extent an unusual finding. With respect to the role of IL-6 in Th2 responses and antibody production, the appearance of this cytokine in campylobacteriosis was more expected.

DISCUSSION

During systemic bacterial infection, a network of pro-inflammatory cytokines is activated and blood levels of these cytokines are elevated, albeit inconsistently, with large individual variations and depending on microbial characteristics and structure.

Primary Campylobacter jejuni infection in different mice strains

Campylobacter jejuni is one of the most frequent causes of diarrhoea in man. Extra-intestinal manifestations may also occur, particularly in immunocompromised individuals. However, because of the lack of appropriate animal models the pathophysiology and immunological response of the host to C. jejuni infection are still poorly understood. In our laboratory an experimental infection of adult BALB/c, C57BL/6 and DBA/2 mice has been established. After intraperitoneal injection of 0.5-1x10(9) cfu of C. jejuni none of the infected mice showed clinical symptoms of illness, but bacterial spreading and tissue invasion were achieved. We have concentrated our studies on the duration of primary infection, recovery of bacteria from livers and spleens of infected animals and pathohistological changes of these organs. Our results showed differences in the course of systemic infection among the tested mice strains. BALB/c mice were most sensitive, resulting in the most pronounced pathohistological changes in the examined organs. The duration of the primary liver infection was the longest in BALB/c mice while the duration of the splenic infection also differed among the tested mice strains. Nevertheless, the experimental model used in this study can be efficiently used in further analysis of the pathogenesis of this bacterial infection. However, the strain differences should be taken into account depending on the parameters to be followed.

Primary Listeria monocytogenes infection in gestating mice

The facultative intracellular Gram-positive bacterium Listeria monocytogenes is a food-borne pathogen of frequently underestimated importance. Pregnant women represent the high-risk group for L. monocytogenes infection. Abortion, stillbirth or neonatal infection can be the serious outcome of such an infection. Recovery from listeriosis, resistance mechanisms of the host and the effect of L. monocytogenes on fetal development still remain to be fully understood. The results of our experiments showed an increased susceptibility of gestating BALB/c mice to primary L. monocytogenes infection. The duration of listeriosis in gestating animals was almost twice longer than in the control group. Furthermore, it was clearly shown that the detrimental effect of L. monocytogenes on fetal development was more pronounced if the infection was acquired earlier during gestation.

Euglobulin lysis times: an update

There are several clot lysis tests available to assess the presence of increased fibrinolysis in a clinical situation. These include whole blood, plasma, and "eugloblin" lysis tests. The euglobulin lysis test (ELT) is actually a modified plasma clot lysis time, which detects increased plasminogen activation and subsequent fibrinolysis. It does not detect the activity of antiplasmins. The purpose of this study was to determine ELT for a group of 25 ambulatory normals. There were 10 males and 15 females, ranging in age from 25 to 56 years. Citrate anticoagulated samples were obtained immediately after application of a tourniquet and 10 minutes after application of a sphygmomanometer inflated to midway between systolic and diastolic pressure. The citrated plasma was precipitated with cold acetic acid. The precipitate contained fibrinogen, plasminogen, and plasminogen activators, with fibrinolytic inhibitors theoretically removed. The precipitate was redissolved and the euglobulin solution was clotted with thrombin. The clotted sample was then incubated at 37 degrees C and was observed at 10 minute intervals for clot lysis.

RESULTS

The reference range of onset of fibrinolysis was from 1.25 to 12 hours, with a mean of 3.78 hours +/- 2.45 hours (1 S.D.). Venostasis (use of the sphygmomanometer) resulted in an ELT that was shorter than the non-venostasis specimens in 11 of 25 specimens. This is thought to be secondary to in vivo activation of plasminogen.

CONCLUSION

The average euglobulin lysis time in 25 ambulatory normals is approximately 3.5 hours. The ELTs vary over a broad range (1.25 to 12.0 hours) in normal ambulatory volunteers.(ABSTRACT TRUNCATED AT 250 WORDS)

[The role of adrenal gland x-ray computed tomography and scintigraphy using radiolabelled norcholesterol in the etiological diagnosis of primary hyperaldosteronism]

The major etiologies of primary aldosteronism are aldosterone-producing adrenal adenoma, requiring a surgical treatment, and bilateral hyperplasia, usually managed with medical therapy. We only report a retrospective study on 22 patients with primary aldosteronism diagnosed by clinical and usual biochemical tests. All the patients were explored by computed tomography scan (CT) and iodomethyl-norcholesterol scintigraphy. The purpose of this study was to compare the capacity of the two methods to differentiate adrenal adenoma and hyperplasia. The CT scan was more sensitive (sensitivity: 88%) compare to scintigraphy (sensitivity: 64%) for the diagnosis of adrenal adenoma. However, the scintigraphy was a useful tool to detect asymmetric macronodular adrenal hyperplasia. Therefore, the catheterisation of adrenal venous would be only necessary for a few cases. We conclude from this study and the literature review that CT scan and iodomethyl-norcholesterol scintigraphy are complementary and both useful to increase diagnostic reliability of primary aldosteronism.

Effect of the endodontic status of the tooth on experimental periodontal reattachment in baboons: a preliminary investigation

The effect of the endodontic status of the tooth on periodontal reattachment after the raising of a mucogingival flap was studied with the use of 48 teeth in four old baboons. Root canal therapy was performed on 26 front teeth. Tubliseal, AH26, N2, and Diaket were used as sealers with gutta-percha. The pulps of 5 teeth were exposed and left infected; 17 teeth with intact pulps served as a control. The teeth and their surrounding structures were studied histologically for reattachment with new cementum formation 2 to 17 days, 1 to 2 months, and up to 1 year after the operation. In the teeth examined 1 month postoperatively or more, if epithelium had not covered the denuded surface, new cementum was present, regardless of the endodontic status.